U.s. Investigating Medicare Practices At 2 Broward Hmos

March 22, 1986|By Joseph Cosco, Staff Writer

The U.S. Department of Health and Human Services and the FBI are investigating two Broward County health maintenance organization clinics thought to be involved in a scheme to defraud the Medicare program.

According to federal court documents, the two HMOs are Doctor`s Gold Plus Center I at 1777 S. Andrews Ave., Fort Lauderdale, and Doctor`s Gold Plus Center II at 4931 S. State Road 7, Davie. The two clinics are independent subcontractors affiliated with International Medical Centers.

Dr. Christino Enriquez, a practicing physician and owner/operator of the two clinics, and Elaine Herold, the administrator of Center I, are the targets of the investigation, according to an affidavit filed in U.S. District Court in Miami.

Officials of International Medical Centers were in contact with the HHS Office of Inspector General and the U.S. Attorney`s Office and were told the company was not a target of the investigation, said spokeswoman Barbara Ferreiro. ``We are offering our fullest cooperation in the investigation of these two centers,`` she said. ``We have no ownership interest in these two centers.``

The alleged scheme ``was to defraud the federally funded Medicare program by prescreening patients prior to enrollment in order to generate additional income for the centers and to screen out those patients who were seriously ill and would be costly for the centers to treat,`` according to the affidavit filed by a special agent with the HHS Office of Inspector General.

No formal charges have been filed in the case, but the investigation is continuing in cooperation with the U.S. Attorney`s Office, said FBI spokesman Paul Miller in Miami. ``Medicare fraud is a problem we`re trying to resolve very quickly,`` he said.

According to the affidavit, HHS special agent Leon Weinstein was tipped off to the alleged scheme by a supervisor at Center II and an employee at Center I, identified in the court documents only as Source I and Source II.

The affidavit claims that the two clinics violated the law by refusing to enroll some patients who qualified for the plan and by billing Medicare for routine physical examinations that were purported to be ``free pre-HMO physical exams.``

Medicare does not pay for physicals that are not related to the diagnosis or treatment of specific ailments.

``After the examination Source I stated that she prepared Medicare claim forms, stating the diagnosis that was indicated by the doctor,`` according to the affidavit. ``If no diagnosis was indicated, pursuant to the instructions of Ms. Elaine Herold, Source I would make one up in order to get Medicare to make the payment. These Medicare forms were all stamped with Dr. Christino Enriquez`s name prior to mailing to Florida Blue Shield for payment.``

The exams also were used to prevent the enrollment of seriously ill, and therefore potentially costly, HMO patients in violation of the clinics` contract with HHS, according to the affidavit.

When International Medical Centers periodically sent representatives to check on the clinics` paperwork, Herold told Source I to lie to them, according to the affidavit.